Multiple contributors to neurocognitive impairment in individuals with sickle cell disease have been identified. Research indicates that a history of cerebrovascular accidents, such as silent infarcts and strokes are associated with greater cognitive decline among children with sickle cell disease. Additionally, disease effects such as hemoglobin and hematocrit levels significantly effect cognitive performance among this population and should be taken into consideration when examining neurocognitive impairment. Further, previous studies show a significant relationship between child behavior problems, family functioning, and cognitive performance in children with sickle cell, marking those as important targets for intervention among this population. While cognitive decline with increased age is not typically examined in healthy child populations, some research indicates the presence of age effects in those with SCD. A majority of the literature addresses cognitive impairment from a broad perspective, while a limited number of studies have begun to address effects among specific cognitive domains. Using archival data from the National Institutes of Health's Cooperative Study of Sickle Cell Disease, results revealed that disease severity was negatively correlated with some aspects of cognitive functioning, including visual-spatial domains. Additionally, some measures of cognitive performance were inversely correlated with age. Consistent with hypothesized outcomes, family functioning was strongly associated with measures of cognitive functioning. Implications are discussed.

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p

[pt] Além da utilização como teste de rastreio, tem-se utilizado o Teste do Desenho do Relógio (TDR) também na avaliação de funcionamento executivo em idosos. Em dissertação de mestrado, construiu-se e validou-se um método de pontuação que classificou as estratégias de construção do TDR. A presente tese tem o objetivo de investigar as estratégias de construção do TDR em idosos com comprometimento cognitivo. 86 idosos (28 controle, 45 com transtorno neurocognitivo leve e 13 com transtorno neurocognitivo maior) participaram dos dois estudos que compuseram a tese. O primeiro analisou as estratégias de construção do TDR e o perfil neuropsicológico dos idosos e o segundo verificou a validade clínica do sistema. Os resultados apresentaram que as subcategorias associadas a melhor funcionamento executivo diminuem ocorrência à medida que o comprometimento cognitivo se acentua e as subcategorias associadas a pior funcionamento executivo aumentam frequência. Verificou-se também que a Estratégia de Sequência Geral Atípica evidenciou validade clínica para diferenciar idosos com transtorno neurocognitivo maior dos demais grupos. Conclui-se que a análise qualitativa das Estratégias de Construção do TDR tem utilidade clínica como medida de funcionamento executivo. / [en] Besides being used as a screening test, the Clock Drawing Test (CDT) has also been used to assess executive functioning in the elderly. In previous study, a scoring method that classified the Construction Strategies of the CDT was constructed and validated. This tesis aims to investigate construction strategies of CDT in elderly with cognitive impairment. 86 elderly (28 controls, 45 with mild neurocognitive disorder and 13 with major neurocognitive disorder) were the participants of the thesis. It was subdivided in two studies. The first one analyzed older adult s Construction Strategies of the CDT and neuropsychological profiles. The second one verified clinical validity of the system. Results showed that the subcategories associated with better executive functioning decrease occurrence as cognitive impairment increases while the subcategories associated with worse executive functioning increase frequency. Atypical General Sequence Strategy also showed clinical validity to differentiate older adults with major neurocognitive disorder from other groups. As conclusion, it is verified that qualitative analysis of the Construction Strategies of the CDT has clinical utility as a measure of executive functioning.

<p>Children with sickle cell disease (SCD) have a high risk of neurocognitive impairment. No known research, however, has examined the impact of neurocognitive functioning on quality of life in this pediatric population. In addition, limited research has examined neurocognitive interventions for these children. In light of these gaps, two studies were undertaken to (a) examine the relationship between cognitive functioning and quality of life in a sample of children with SCD and (b) investigate the feasibility and preliminary efficacy of a computerized working memory training program in this population. Forty-five youth (ages 8-16) with SCD and a caregiver were recruited for the first study. Participants completed measures of cognitive ability, quality of life, and psychosocial functioning. Results indicated that cognitive ability significantly predicted child- and parent-reported quality of life among youth with SCD. In turn, a randomized-controlled trial of a computerized working memory program was undertaken. Eighteen youth with SCD and a caregiver enrolled in this study, and were randomized to a waitlist control or the working memory training condition. Data pertaining to cognitive functioning, psychosocial functioning, and disease characteristics were obtained from participants. The results of this study indicated a high degree of acceptance for this intervention but poor feasibility in practice. Factors related to feasibility were identified. Implications and future directions are discussed.</p> / Dissertation

Objetivos: Este trabalho teve como objetivo determinar a prevalência e os fatores associados às alterações neurocognitivas em uma coorte de pacientes portadores do HIV-1 vinda do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC-FMUSP, com alto nível de adesão aos antirretrovirais e baixa prevalência de doenças oportunistas associadas ao vírus. Metodologia: A prevalência de alterações neurocognitivas associadas ao HIV (HAND) foi avaliada através de uma bateria neuropsicológica estruturada composta por 8 instrumentos, possibilitando uma abrangência maior em relação a quantidade de funções cognitivas superiores avaliadas e maior precisão na detecção das alterações. Resultados: A amostra foi composta por 54 pacientes e a análise dos dados mostrou elevada prevalência de HAND na amostra analisada (60%), independente do controle imunológico e virológico, com maior presença da forma assintomática (ANI), porém o resultado da forma leve (MND) também foi significativo, sendo próximo à porcentagem dos pacientes com a forma assintomática. Conclusão: Os resultados do estudo refletiram o cenário nacional e internacional mostrando a alta prevalência das alterações cognitivas associadas ao HIV, alertando os profissionais de saúde para a importância de identificação, diagnóstico e acompanhamento adequado desses pacientes. Os dados também mostraram a importância da presença do profissional da área de psicologia na equipe de saúde, oferecendo ao paciente o desenvolvimento de estratégias de atendimento mais específicas e eficazes / The main goal of this study was to determine the prevalence and factors associated with neurocognitive disorders in a cohort of 54 patients with HIV-1 from the Blood Bank of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC- FMUSP with high adherence to antiretroviral therapy and low prevalence of opportunistic diseases associated with the virus. Methods: The prevalence of HIV associated neurocognitive disorders (HAND) was evaluated through a structured neuropsychological battery of 8 tests, increasing the coverage of superior cognitive functions being evaluated and greater precision in the detection of cognitive alterations. Results: Data analysis showed a high prevalence of HAND in the population under analysis (60%), irrespective of the immunological and virologic control, with a greater presence of the asymptomatic form (ANI), but the occurrence of the mild form (MND) was also significant, being close to the percentage of patients with the asymptomatic form. Conclusion: The result of the study reflected the national and international scenario showing high prevalence of HIV associated neurocognitive disorders, alerting health professionals to the importance of identification, diagnosis and adequate follow-up of these patients. The data also showed the importance of the presence of the psychologist in the health team, offering to the patient more specific and effective care strategies

People with neurocognitive disorders (NCD) condition called dementia are mainly taken care by family members. The number of people suffering from neurocognitive disorders is estimated to increase. Providing care for the person with NCD can be stressful and demanding which is why effective interventions to support caregivers are needed. Occupational therapy practitioners have unique knowledge of the person, environment and occupation and how those factors influence on individuals occupational performance. Occupational therapy ́s interventions to support caregivers with NCD have mainly concentrated on problems in the behaviour of person with NCD. The aim of this scoping review was to identify why some caregivers are managing better as a caregiver before any interventions have been done. What are those aspects of Person (P), Occupation (O) and Environment (E) that facilitate occupational performance (OP) when taking care for a person with NCD. PEO-model by Law et. al (Law et al., 1996) was utilized to formulate research question, in search words and in summarizing the results. The search from Ageline, Cinahl, Psycinfo and PubMed databases was done in January 2018 and went back 10 years. Results found 23 relevant articles for inclusion in the scoping review. Facilitating factors emphasized the supports of relationship seen as an overlap of caregivers and individuals with NCD on occupational performance. Facilitating personal factors of resilience, finding gains in caregiving, self -efficacy and religiosity were found to have an impact on care that the caregiver provides. Facilitative aspects of occupations highlighted importance of daily occupations as a source of well-being for both caregiver and person with NCD. In conclusion, facilitating aspects of relationships, personal factors and engagement in activities and hobbies supported occupational performance of both the caregiver and a person with NCD. Taking these factors into consideration could help target interventions more precisely to meet caregivers needs.

A new, biologically plausible model of task-set learning that reproduces effects from both rule-learning experiments and task-switching experiments.<br>

Submitted by Claudia Cristina de Góes null (claudia_crgoes@hotmail.com) on 2016-10-25T00:07:10Z No. of bitstreams: 1 Dissertação versão final_claudia_c_goes.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-10-31T13:53:47Z (GMT) No. of bitstreams: 1 goes_cc_me_bauru.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) / Made available in DSpace on 2016-10-31T13:53:47Z (GMT). No. of bitstreams: 1 goes_cc_me_bauru.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) Previous issue date: 2016-06-03 / A estimativa de pessoas vivendo com HIV/AIDS é de 734mil, a maior concentração de casos é na população com idade entre 25 e 39 anos desde 1980 até junho de 2014. Devido à supressão do sistema imune e queda do número de células de defesa CD4, o paciente pode ser acometido por alterações no funcionamento fisiológico e por doenças oportunistas, incluindo as manifestações neurológicas, como os transtornos neurocognitivos associados ao HIV (HAND; HIV-associated neurocognitive disorders). Pessoas com HAND geralmente apresentam comprometimento da aprendizagem e das habilidades motoras, alterações de humor e déficits nos domínios cognitivos, os quais são classificados conforme a gravidade como leve, moderada ou grave e podem comprometer a adesão ao tratamento com antirretrovirais e à qualidade de vida. Contudo, a relação entre estas variáveis, cruciais para a sobrevivência do paciente, não se encontra estabelecida, sendo o envelhecimento uma das variáveis a esclarecer. Objetivou-se traduzir e adaptar o instrumento Simplified Medication Adherence Questionnaire (SMAQ); avaliar e comparar diferenças do desempenho cognitivo entre dois grupos em função da idade e identificar relações entre Qualidade de Vida e adesão à Terapia Antirretroviral combinada. Foram avaliados 50 voluntários com idades entre 21 e 58 anos e divididos em dois grupos (jovens e maduros) que participaram do protocolo completo, composto por testes cognitivos (domínios cognitivos: atenção, memória, linguagem e inteligência) e escalas de rastreio de depressão, ansiedade, uso de drogas psicoativas, adesão ao tratamento e qualidade de vida e situação socioeconômica. Como resultados, foram encontradas diferenças significativas entre os grupos nos seguintes domínios cognitivos: memória episódica, memória operacional, linguagem, processamento visuoespacial e função sensório-motora, tornando possível observar a influência da idade sobre o comprometimento cognitivo em pessoas vivendo com HIV. / In Brazil, 734,000 people are currently estimated to live with HIV / AIDS, and most cases concentrate in the 25 to 39 year-old population born from 1980 to June 2014. Due to suppression of immune system and fall in the number of CD4 T immune cells, a patient may be affected by changes in physiologic functioning and opportunistic diseases, including neurological manifestations such as HIV-associated neurocognitive disorders (HAND). People with HAND usually present learning and motor skills impairments, mood changes, and deficits in cognitive domains, which are classified according to gravity as mild, moderate or severe and may compromise adherence to antiretroviral therapy and quality of life. However, the relation between those variables, which are critical to a patient’s survival, has not been established yet, and aging is a variable to be clarified. The objective of this study was to translate and to adapt the Simplified Medication Adherence Questionnaire (SMAQ) to Brazilian Portuguese; to evaluate and to compare differences in cognitive performance between two groups according to age; and to identify and to compare relations between quality of life and adherence to cART (Combination Antiretroviral Therapy) In this study, 50 volunteers, aged from 21 to 58 years old, were assessed and divided into two groups (young adults and mature). Both groups took part of the full protocol, composed by cognitive tests (cognitive domains: attention, memory, language, and intelligence) and screening scales for depression, anxiety, use of psychoactive drugs, treatment adherence and quality of life, and socioeconomic status. As a result, significant differences between the groups were found in the following cognitive domains: episodic memory, working memory, language, visuospatial processing and sensory-motor function, which made it possible to observe age influence on the cognitive impairment of people living with HIV.

Objetivos: Este trabalho teve como objetivo determinar a prevalência e os fatores associados às alterações neurocognitivas em uma coorte de pacientes portadores do HIV-1 vinda do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC-FMUSP, com alto nível de adesão aos antirretrovirais e baixa prevalência de doenças oportunistas associadas ao vírus. Metodologia: A prevalência de alterações neurocognitivas associadas ao HIV (HAND) foi avaliada através de uma bateria neuropsicológica estruturada composta por 8 instrumentos, possibilitando uma abrangência maior em relação a quantidade de funções cognitivas superiores avaliadas e maior precisão na detecção das alterações. Resultados: A amostra foi composta por 54 pacientes e a análise dos dados mostrou elevada prevalência de HAND na amostra analisada (60%), independente do controle imunológico e virológico, com maior presença da forma assintomática (ANI), porém o resultado da forma leve (MND) também foi significativo, sendo próximo à porcentagem dos pacientes com a forma assintomática. Conclusão: Os resultados do estudo refletiram o cenário nacional e internacional mostrando a alta prevalência das alterações cognitivas associadas ao HIV, alertando os profissionais de saúde para a importância de identificação, diagnóstico e acompanhamento adequado desses pacientes. Os dados também mostraram a importância da presença do profissional da área de psicologia na equipe de saúde, oferecendo ao paciente o desenvolvimento de estratégias de atendimento mais específicas e eficazes / The main goal of this study was to determine the prevalence and factors associated with neurocognitive disorders in a cohort of 54 patients with HIV-1 from the Blood Bank of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC- FMUSP with high adherence to antiretroviral therapy and low prevalence of opportunistic diseases associated with the virus. Methods: The prevalence of HIV associated neurocognitive disorders (HAND) was evaluated through a structured neuropsychological battery of 8 tests, increasing the coverage of superior cognitive functions being evaluated and greater precision in the detection of cognitive alterations. Results: Data analysis showed a high prevalence of HAND in the population under analysis (60%), irrespective of the immunological and virologic control, with a greater presence of the asymptomatic form (ANI), but the occurrence of the mild form (MND) was also significant, being close to the percentage of patients with the asymptomatic form. Conclusion: The result of the study reflected the national and international scenario showing high prevalence of HIV associated neurocognitive disorders, alerting health professionals to the importance of identification, diagnosis and adequate follow-up of these patients. The data also showed the importance of the presence of the psychologist in the health team, offering to the patient more specific and effective care strategies

Made available in DSpace on 2016-03-15T19:40:22Z (GMT). No. of bitstreams: 1 Maria Aparecida Bernardes Orlandi.pdf: 573960 bytes, checksum: 40c15cb8f5dd9faf220d051de6f44829 (MD5) Previous issue date: 2006-12-12 / Fundo Mackenzie de Pesquisa / The aim of this research was to identify in literature, possible variations and some relationship among aggression, neuroendocrine stress and neurocognitive deficit. A meta-analysis was conduct based on reviews, essays and thesis, on electronic database selected from 1996 to 2006, on MEDLINE, ERIC and CAPES. From a total of 371 selected researches, 41 were considered relevant, 330 were rejected because they did not satisfied the criteria of the analysis due to psychobiological context of aggression development in childhood related to the subject. The results suggested at least 7 different perspectives through childhood aggression could be analysed with favorable hypothesis, evidences and considerations related to neuroendocrine stress and neurocognitive deficit as co-occurrent with aggression in case of convergent situations of multifactorial vulnerability of the child. / O objetivo deste trabalho foi identificar na literatura, possível variação da agressividade e sua relação com o estresse neuroendócrino e déficit neurocognitivo na infância. Foi conduzida uma meta-análise baseada em artigos de revisão, dissertações e teses, selecionados nas fontes eletrônicas do MEDLINE, ERIC E CAPES, no período de 1996 a 2006. Do total de 371 artigos selecionados, 41 foram considerados relevantes, 330 foram descartados por não cumprirem os critérios para a análise devido ao contexto psicobiológico do desenvolvimento da agressividade na infância relacionado ao tema da pesquisa. Os resultados demonstraram pelo menos 7 diferentes perspectivas pelas quais a agressividade infantil pode ser analisada, com hipóteses, evidências e considerações favoráveis à relacionar o estresse neuroendócrino e déficit neurocognitivo como coocorrentes com a agressividade, em situações de convergência multifatorial e de vulnerabilidade da criança.